内容紹介
StageⅣ Gastric Cancer Made Resectable Following a Chemotherapy Regimen That Included Trastuzumab―A Case Report
Summary
A 70-year-old man was referred to our hospital after anemia was identified by his general practitioner. A detailed examination led to the diagnosis of unresectable StageⅣ gastric cancer with metastasis to the paraaortic lymph nodes. The cancer was HER2-positive; therefore, the patient was administered trastuzumab, capecitabine, and cisplatin combination therapy. A remarkable reduction in the size of the lymph nodes was observed. The reduction in the size of the metastatic foci was accompanied by enlargement of the primary tumor, which was considered an indication for surgery. He underwent total gastrectomy, and histopathology showed absence of cancerous cells in the resected lymph nodes, indicating a curative resection. In Japan, trastuzumab, capecitabine, and cisplatin combination therapy is currently recommended as the standard therapy for unresectable advanced/recurrent HER2-positive gastric cancer, and the findings of the present case suggest that it may also be useful as neoadjuvant chemotherapy.
要旨
症例は70歳,男性。近医で貧血を指摘され当院紹介となった。精査の結果,腹部大動脈周囲リンパ節転移を伴うStageⅣ胃癌で治癒切除不能と診断した。生検にてHER2陽性であったため,trastuzumab+capecitabine+cisplatin療法を行ったところ,腫大リンパ節に著明な縮小がみられた。転移巣が制御されたことに加え,原発巣の増大傾向が認められたため手術適応と判断し,胃全摘術を施行した。切除リンパ節には病理学的に癌細胞が認められず,治癒切除がなされたと判断した。現時点においてわが国では,HER2陽性の切除不能進行・再発胃癌に対する標準治療としてtrastuzumab+capecitabine+cisplatin療法が推奨されているが,本症例では本療法の術前化学療法としての有用性が示唆された。
目次
Summary
A 70-year-old man was referred to our hospital after anemia was identified by his general practitioner. A detailed examination led to the diagnosis of unresectable StageⅣ gastric cancer with metastasis to the paraaortic lymph nodes. The cancer was HER2-positive; therefore, the patient was administered trastuzumab, capecitabine, and cisplatin combination therapy. A remarkable reduction in the size of the lymph nodes was observed. The reduction in the size of the metastatic foci was accompanied by enlargement of the primary tumor, which was considered an indication for surgery. He underwent total gastrectomy, and histopathology showed absence of cancerous cells in the resected lymph nodes, indicating a curative resection. In Japan, trastuzumab, capecitabine, and cisplatin combination therapy is currently recommended as the standard therapy for unresectable advanced/recurrent HER2-positive gastric cancer, and the findings of the present case suggest that it may also be useful as neoadjuvant chemotherapy.
要旨
症例は70歳,男性。近医で貧血を指摘され当院紹介となった。精査の結果,腹部大動脈周囲リンパ節転移を伴うStageⅣ胃癌で治癒切除不能と診断した。生検にてHER2陽性であったため,trastuzumab+capecitabine+cisplatin療法を行ったところ,腫大リンパ節に著明な縮小がみられた。転移巣が制御されたことに加え,原発巣の増大傾向が認められたため手術適応と判断し,胃全摘術を施行した。切除リンパ節には病理学的に癌細胞が認められず,治癒切除がなされたと判断した。現時点においてわが国では,HER2陽性の切除不能進行・再発胃癌に対する標準治療としてtrastuzumab+capecitabine+cisplatin療法が推奨されているが,本症例では本療法の術前化学療法としての有用性が示唆された。